Do I need a breast lift? An augment? Both?

This question is a common focal point of discussion during consultation for cosmetic breast surgery, and it’s critical to make the right decision. The patient will not be happy with the result if the wrong surgery is recommended and performed. That concept seems pretty obvious, but you would be surprised at how often the wrong surgery is recommended.


More women think they need a breast lift (mastopexy) than actually do. The way plastic surgeons define droopiness, or what we call ptosis (toe-sis), is by determining where the nipple sits relative to the inframammary fold (imf). Many women have some laxity of their breasts following pregnancy and breastfeeding that causes some skin on skin contact under the breast, and yet the nipple sits at or above the imf. This is referred to as glandular ptosis and often does not need a mastopexy. If, on the other hand, a breast has both gland and the nipple and areola below the imf, the starting point will have to be a mastopexy. This will reposition the nipple and areola upwards to the level of the imf.

A mastopexy alone does not give upper pole fullness. Upper pole fullness is the fullness that is often sought after by patients and created via push up bras. A mastopexy improves the position of the nipple and shape of the breast without creating the upper pole convexity that some women desire. In order to achieve that contour, the addition of an implant is required. The combination of a breast lift and breast augmentation can have a dramatic effect on the appearance of a breast with improvements in volume, aesthetic nipple position, areola resizing, and improved contour.

The topic and decisions are complex. If you have questions or are interested in aesthetic breast surgery please contact our office. We would be happy to help.